Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3079 — Race and the Use of Percutaneous Coronary Intervention in Veterans with Acute Myocardial Infarction

Author List:
Sun H. (Northwest Center for Outcomes Research in Older Adults)
Maynard C (Northwest Center for Outcomes Research in Older Adults)
Sales AE (Northwest Center for Outcomes Research in Older Adults)
Fihn SD (Northwest Center for Outcomes Research in Older Adults)

Objectives:
In the past, African-American (AA) veterans hospitalized with acute myocardial infarction (AMI) were less likely to undergo percutaneous coronary intervention (PCI) than their white counterparts. The purpose of this study is to determine if in the era of drug eluting stents, AA veterans with AMI are less likely to receive PCI.

Methods:
There were 4209 veterans who had a first documented AMI and were discharged from VHA medical centers between July 2003 and August 2004. Veterans of other or unknown races were excluded. Information for this study was collected as part of the VHA External Peer Review Program (EPRP).

Results:
The 680 (16%) AA were younger and more likely to be current smokers than their 3529 white counterparts. They also had more diabetes or renal disease, but less often had previous coronary artery surgery or chronic lung disease. Compared to white veterans, AA were more often admitted to VA medical centers that performed PCI (75% vs. 54%, p<0.0001). In facilities without PCI capability, 1% of both AA and whites had PCI < 12 hours from admission (p=0.88), and 51% of AA and 49% of whites underwent cardiac catheterization < 30 days from admission for AMI (p=0.59). For the group with cardiac catheterization, 48% of AA and 65% of whites had PCI < 30 days from AMI (p=0.0002). A lower proportion of AA patients were transferred for PCI (20% vs. 29%, p=0.014). For veterans admitted to facilities with PCI, 10% of AA and 14% of white patients underwent PCI < 12 hours from admission (p=0.027). Cardiac catheterization < 30 days from admission was performed in 61% of AA and 64% of whites (p=0.19); yet 30 day rates of PCI were lower in AA who underwent cardiac catheterization (49% vs 56%, p=0.017).

Implications:
Despite similar rates of cardiac catheterization, African-Americans continue to undergo PCI less often than their white counterparts.

Impacts:
This disparity has been consistently reported for the past 10 years, although the reasons for it are not clear. Further research is needed to understand the sources of disparate treatment.